ERECTILE DYSFUNCTION

ARDIE A. BLAND · 2026 · Case ID: A26030502

DENIED

Summary

The veteran, who served from August 1973 to April 1976, appeals the denial of service connection for erectile dysfunction, sleep apnea, and headaches. The veteran contends that erectile dysfunction is secondary to diabetes mellitus medication, and that sleep apnea and headaches are related to active duty service. The Board found that the first element of service connection (current disability) was met due to favorable findings in a prior rating decision for all three conditions. However, the Board found that the second element (in-service event, injury, or disease) was not met, as the veteran's service treatment records were silent regarding any treatment or symptoms related to these conditions. The earliest evidence for erectile dysfunction was from 2010, sleep apnea from 2024, and headaches from 2008, all significantly after separation from service. The Board also noted the absence of any continuity of symptomatology or competent medical evidence linking the conditions to service. Consequently, the Board found that a VA examination was not warranted as the claims failed the McLendon criteria, and the evidence persuasively weighed against service connection. The benefit-of-the-doubt rule did not apply as the evidence was not in approximate balance. Service connection for all three conditions was denied.

Rationale

No in-service event, injury, or disease documented; No continuity of symptomatology; Earliest evidence post-service

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251223-617889

Full Decision Text

Citation Nr: A26030502
Decision Date: 04/02/26 Archive Date: 04/02/26

DOCKET NO. 251223-617889
DATE: April 2, 2026

ORDER

Entitlement to service connection for erectile dysfunction is denied.

Entitlement to service connection for sleep apnea is denied.

Entitlement to service connection for headaches is denied.

FINDINGS OF FACT

1. The evidence of record is persuasively against finding that the Veteran's erectile dysfunction arose in service, is related to service, or is caused by or aggravated by a service-connected disability.

2. The evidence of record is persuasively against finding that the Veteran's sleep apnea arose in service or is related to service.

3. The evidence of record is persuasively against finding that the Veteran's headaches arose in service or are related to service.

CONCLUSIONS OF LAW

1. The criteria for service connection for erectile dysfunction have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307; 3.309; 3.310.

2. The criteria for service connection for sleep apnea have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307; 3.309; 3.310.

3. The criteria for service connection for headaches have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307; 3.309; 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from August 1973 to April 1976, with additional periods of service in the National Guard.

This case comes before the Board of Veterans' Appeals (Board) on appeal from a February 2025 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

The AMA creates a new framework for Veterans dissatisfied with VA's decision on their claim to seek review. The AMA became effective on February 19, 2019. 38 C.F.R. § 3.2400 (a)(1). The rating decision in this case was issued after February 19, 2019; thus, the AMA framework applies.

In the December 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the February 2025 Agency of Original Jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Entitlement to service connection for erectile dysfunction

Entitlement to service connection for sleep apnea

Entitlement to service connection for headaches

The Veteran contends his erectile dysfunction is secondary to his diabetes mellitus medication, and his sleep apnea and headaches are related to his active duty service. See December 2023 VA Form 21-526EZ and Report of General Information.

Service connection may be granted for a disability resulting from disease or injury incurred or aggravated by active service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303 (a). In general, service connection requires (1) evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 382 F.3d 1163, 1167 (Fed.
incurred or aggravated by active service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303 (a). In general, service connection requires (1) evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 382 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease or injury diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303 (d).

Service connection may be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). To establish secondary service connection there must be evidence: (1) of a current disability (for which secondary service connection is sought); (2) of an already service-connected disability; and (3) that the current disability for which service connection is sought was either (a) caused or (b) aggravated by the service-connected disability. 38 C.F.R. §3.310(a); see Allen v. Brown, 7 Vet. App. 439 (1995) (en banc).

If a veteran had active service in Korea between April 1, 1968 and August 31, 1971 in a unit that, as determined by the Department of Defense, operated in or near the Korean demilitarized zone (DMZ) in an area in which herbicides are known to have been applied during that period, shall be presumed to have been exposed to an herbicide agent unless there is affirmative evidence of non-exposure. See 38 C.F.R. § 3.307 (a)(6)(iv).

Disease associated with exposure to certain herbicide agents, listed in 38 C.F.R. § 3.309, will be considered to have been incurred in service under the circumstances outlined in that section even though there is no evidence of such disease during the period of service. If a veteran was exposed to an herbicide agent during active military, naval, or air service, specified diseases shall be service connected if the requirements of 38 C.F.R. § 3.307 (a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307 (d) are also satisfied.

In deciding an appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990).

When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran's disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011). A Veteran is competent to describe symptoms that he experienced in service or at any time after service when the symptoms he perceived or experienced were directly through the senses. 38 C.F.R. § 3.159; Layno v. Brown, 6 Vet. App. 465, at 469-71 (1994). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (Fed. Cir. 2007).

In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104 (a). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Lynch v. McDonough,
or symptoms that later support a diagnosis by a medical professional. Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (Fed. Cir. 2007).

To begin, as noted above, if a veteran was exposed to an herbicide agent during active service, certain enumerated diseases will be presumed to have been incurred in service if manifest to a compensable degree within specified periods, even if there is no record of such disease during service. Recently, the list of enumerated diseases was expanded to include bladder cancer, hypothyroidism, and Parkinsonism to the list of those conditions presumptively associated with exposure to Agent Orange, but not erectile dysfunction, sleep apnea, or headaches. As such, service connection cannot be granted on a presumptive basis. Although service connection cannot be granted for these conditions on a presumptive basis for exposure to herbicides, this does not preclude the Veteran from establishing service connection on a direct basis. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

Secondly, at the time of this decision, the Board observes that the Veteran is not service-connected for any disabilities. Therefore, the second element for secondary service connection cannot be met for any of the claimed disabilities in this matter.

Thus, the only remaining theory of entitlement is direct service connection. The Board observes the February 2025 rating decision made the following favorable findings: a current diagnosis of erectile dysfunction as shown in treatment records from September 2010, a current diagnosis of morning headaches from treatment records in July 2023, and a current diagnosis of sleep apnea from a sleep study in November 2024. The Board is bound by these favorable findings. 38 C.F.R. 3.104(c). Therefore, the Board finds the first element of service connection is met for all three claims.

Turning to the second and third elements of service connection, the Board observes the Veteran's service treatment records are silent for any treatment related to erectile dysfunction, sleep apnea, or headaches. All reports of medical history and reports of medical examination done both during active duty and during service in the National Guard do not indicate any reports of symptoms related to these three conditions.

For the claim of erectile dysfunction, the Board observes this condition was diagnosed in September 2010, with a reported history of erectile dysfunction. His medication was increased at this visit. This condition has been present on his active problems list in treatment notes since September 2010. In April 2014, the Veteran reported his erectile dysfunction had been a problem for some time but had worsened with his depression and bipolar medications. In April 2023, during treatment for diabetes mellitus, the Veteran's provider discussed the goal of keeping his blood sugar under 180 for erectile dysfunction symptoms.

For the claim of sleep apnea, the Veteran reported in April 2023 that he does not snore and was not tired during the day. He was diagnosed with encephalopathy at this visit and referred for a sleep study, as he reported sleeping only 1 to 2 hours per night before awakening. In July 2023, the Veteran again denied snoring, gasping during sleep, and episodes of stopped breathing during sleep. In November 2024, the Veteran's treatment records indicated he was recently diagnosed with severe obstructive sleep apnea. It was noted that he was referred for loud snoring, excessive daytime sleepiness and tiredness, and witness apneic events. His in home test in December 2023 showed obstructive sleep apnea.

In terms of the Veteran's headaches, the Board observes that the Veteran reported use of Advil to treat a headache in November 2008. In June 2009, the Veteran reported that a side effect of the use of tramadol was headaches in treatment for his back pain. In March 2014, the Veteran reported physical signs of cravings included headaches during SATP group therapy. In July 2020, the Veteran reported morning headaches as a result of suboxone withdrawal symptoms.

The Board notes that the Veteran has not received a formal VA examination for his claimed erectile dysfunction
and tiredness, and witness apneic events. His in home test in December 2023 showed obstructive sleep apnea.

The Board notes that the Veteran has not received a formal VA examination for his claimed erectile dysfunction, sleep apnea, or headaches, as part of his claims for entitlement to service connection. However, for the following reasons, the Board finds that a formal VA examination is not warranted.

In McLendon v. Nicholson, the United States Court of Appeals for Veterans Claims ("CAVC") held that an examination is required when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing an "in-service event, injury or disease," or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the current disability may be related to the in-service event, but (4) insufficient evidence to decide the case. McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006).

Here the Board finds the first McLendon element, the evidence of a current disability, is satisfied as by the AOJ's favorable findings in the February 2025 rating decision for all three claims.

The second McLendon element requires evidence establishing an "in-service event, injury or disease," or a disease manifested in accordance with presumptive service connection regulations occurred which would support incurrence or aggravation. McLendon, 20 Vet. App. at 82. The CAVC has found that the assessment of whether the evidence establishes the Veteran suffered an event, injury or disease in service is a "classic factual assessment, involving the weighing of facts." Id.; see Duenas v. Principi, 18 Vet. App. 512, 517 (Vet. App. 2004) (noting that a medical examination could not aid in substantiating a claim where the record does not already contain evidence of an in-service event, injury, or disease). Ordinarily, the Veteran's service treatment records are to be relied on for primary evidence that an in-service event, injury, or disease occurred. As discussed earlier, the Board notes that there is no mention of any of these conditions or related event, injury, or disease in the Veteran's service medical or personnel records. As such, the Board finds that the Veteran has failed to establish "in-service event, injury or disease," and thus fails to fulfill the requirement of the second element of the McLendon analysis. See McLendon, 20 Vet. App. at 82.

The third McLendon element requires an indication that the current disability may be related to the in-service event. The CAVC has held that the requirement that a disability "may be associated" with service is a "low threshold" standard. McLendon, 20 Vet. App. at 83. "The types of evidence that 'indicate' that a current disability 'may be associated' with military service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation." McLendon, 20 Vet. App. at 83. Here the Veteran's claims file lacks evidence beyond the Veteran's filing of the claim, without any statement alleging any possible relationship of any of these conditions with his military service. As discussed above, the earliest possible evidence of erectile dysfunction is from 2010, which is over 34 years after the Veteran's separation from service, for headaches is from 2008, which is over 32 years after the Veteran's separation from service, and for sleep apnea is from 2023, which is 47 years since separation from service.

Furthermore, there are no reports or statements from the Veteran of continuity of symptomatology related to the claimed conditions. There is also no competent medical evidence linking the Veteran's claimed conditions with his military service.

The Board finds that the Veteran's claim fails to satisfy the requirements of McLendon, and thus remand is not warranted for a VA examination regarding erectile dysfunction, sleep apnea, and headaches. 38 U.S.C. § 5103A(d); McLendon, 20 Vet. App. at 82-83;
headaches is from 2008, which is over 32 years after the Veteran's separation from service, and for sleep apnea is from 2023, which is 47 years since separation from service.

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Accordingly, the most probative evidence of record persuasively weighs against the claim of entitlement to service connection for erectile dysfunction, sleep apnea, and headaches. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt rule does not apply and service connection for erectile dysfunction, sleep apnea, and headaches is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Ardie A. Bland

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Huber, C.

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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